What Is Hammer Toe?

Why won't that toe lie flat any more? If the second, third or fourth toe has started to bend downward at its middle joint — so the tip points down and the knuckle sticks up, rubbing on your shoe — you're probably looking at a hammer toe. The video at the top of this page, "Hammer toe and bunion surgery", runs 1 minute 38 seconds and follows a combined surgical case: its description notes that hammer toes and bunions are common foot problems, and the patient travelled for treatment of both together. That pairing is typical — the two deformities often arrive in the same foot.

Which joint bends, and why?

A hammer toe is a bend at the middle joint of a smaller toe. Normally, muscles and tendons on the top and underside of the toe balance each other and keep it straight. When that balance is lost, the underside tendons win, the middle joint flexes, and the toe takes on the hammer-like shape that gives the condition its name. Why does the balance tip? Sometimes the toe is simply long and gets crowded in shoes; sometimes a bunion pushing the big toe sideways squeezes its neighbours; sometimes the foot's structure or a previous injury sets it off. Early on, you can usually still straighten the toe with your fingers — clinicians call that flexible. Left under the same pressures for years, the joint can stiffen until it no longer straightens, and that flexible-versus-fixed distinction shapes everything that follows.

What will you actually feel?

Often, surprisingly little at first — just a toe that looks odd. The complaints tend to come from friction: the raised knuckle rubs the top of the shoe, so the skin there thickens into a corn or callus and aches by the end of the day, and the tip of the toe, now bearing weight it wasn't designed for, can become sore underneath. Shoes with a shallow toe box become the daily enemy. If a neighbouring big toe is drifting because of a bunion at the same time, our guide to bunions explains that side of the picture — the two articles are worth reading together if both patterns sound familiar.

How does a clinician sort it out?

The examination is mostly looking and feeling. Expect the clinician to watch the foot standing and sitting, try gently to straighten the toe to judge whether the joint is still flexible, and check where the painful thickened skin sits. They'll ask which shoes hurt and whether the bend is progressing. An X-ray, usually taken standing, may be used to see the joint alignment — particularly if surgery is being considered, because the images help plan what would need to be corrected. In a typical case the diagnosis itself rarely needs elaborate testing; the important questions are how stiff the joint has become and how much it is limiting you.

What can be done, step by step?

Care usually starts with the shoe, not the scalpel. A roomier toe box that stops the raised knuckle rubbing, padding over the sore spot, and in some cases a simple splint or strap that holds the toe straighter can settle a flexible hammer toe's symptoms, even though they won't permanently reverse a bend that has become fixed. Exercises to keep the toe mobile are sometimes suggested while it is still flexible. Surgery enters the conversation when pain persists despite sensible footwear, when the skin keeps breaking down over the knuckle, or when the toe can no longer be straightened at all. Operations aim to straighten the joint and rebalance the tendons, and the exact technique depends on that flexibility question from the examination. The anchor video above shows the surgical end of this road for a combined hammer-toe and bunion case; for a closer look at bunion surgery itself, the recording "Bunion Surgery: Relief from Foot Pain" (4 minutes 56 seconds) follows a podiatrist performing a bunionectomy.

Frequently Asked Questions

Is a hammer toe the same as a bunion?

No. A bunion is the big-toe joint drifting out of line; a hammer toe is a bend at the middle joint of a smaller toe. They are different deformities, but they often occur in the same foot — a bunion can crowd the neighbouring toes and contribute to a hammer toe.

Can a hammer toe straighten itself out?

A flexible hammer toe can still be straightened by hand, and reducing shoe pressure can ease its symptoms, but the bend does not usually correct itself on its own. Over time an untreated joint may stiffen so it no longer straightens, which is why persistent changes are worth having examined.

When should a hammer toe be checked promptly?

Book a check if the toe is regularly painful, the skin over the knuckle keeps breaking down, you cannot straighten the toe, or shoes no longer fit. Anyone with diabetes or poor circulation who develops a sore or break in the skin on a toe should seek assessment promptly, because foot wounds in that setting need careful care.

MedicalVideos.com has published trusted medical videos since 2007. The site was founded by Dr. Mohamed Ibrahim, MD, PhD — physician-scientist.

Educational only — this article is general information about hammer toe, not medical advice and not a diagnosis. Persistent toe pain or skin breakdown should be assessed by a clinician who can examine your foot.